Our Editor's Choice for September is an evaluation of outcomes in subjects with end-stage chronic respiratory failure and extreme hypercarbia receiving noninvasive ventilation(NIV) despite a do-not-intubate (DNI) order. Lemyze and coworkers found that comatose and non-comatose subjects had similar outcomes. Uniquely, they surveyed surviving subjects who overwhelmingly were willing to receive NIV again, if they developed respiratory failure. Davies contributes anaccompanying editorial reviewing the use of NIV in end-of-life scenarios, including patients with DNI orders.
Rezoagli and co-investigators report their evaluation of aleak proof endotracheal tube cuff in a porcine model. Usinga double layer cuff they report that bacterial colonization of the lung was reduced three-fold. Using methylene blue placedabove the cuff they also noted no leakage with the double layer cuff. The search for the ideal cuff material, shape and pressure has been studied intently over the last decade with fewclinical successes. In an editorial, Young reviews the state of the art regarding cuff designs and the possibility of reducing ventilator-associated pneumonia by altering the endotracheal tube.
Obesity is a worldwide epidemic challenging care giversacross disciplines. Tlayjeh et al provide a sub-analysis of subjects from the OSCILLATE trial, evaluating the impact of body mass index (BMI) on mortality. In previous studies, anobesity paradox has been reported, showing improved ICU outcomes in obese subjects. This paper does not find anydifference in mortality across the range of BMI. Diehl opinesthat changes in chest wall compliance in obesity might providea chance to personalize mechanical ventilation. The use of esophageal pressure could guide both end-inspiratory and end-expiratory pressures.
Bourassa and others followed their previous work byevaluating the impact of a gas mask on respiratory function in agroup of subjects with COPD. They demonstrated that indicesof respiratory effort increased slightly in stable COPD subjects owing to increased inspiratory resistance of the mask. These data suggest COPD subjects can tolerate gas mask use withoutsignificant distress.
Almojaibel et al evaluated the acceptance of telemedicine pulmonary rehabilitation by both caregivers and patients. They specifically studied perceived usefulness, perceived ease ofuse, and behavioral intention. The authors conclude that the content and face validity warrant further psychometric testingas a measure of rehabilitation programs.
Benzo and colleagues evaluated health coaching byrespiratory therapists and nurses on the self-management abilities of COPD subjects. Using the Chronic RespiratoryQuestionnaire (CRQ) Mastery Domain, they found that healthcoaching by both caregivers improved self-management skillsof subjects. They concluded that health coaching followinghospitalization for an exacerbation of COPD improves self-management compared to a control group.
Abu-Sultaneh and coworkers addressed the issue of pediatricairway management in community hospitals. Pediatric emergencies in community hospitals are often seen as n of 1 disasters. The authors provided a multi-faceted program aimedat improving pediatric airway management in communityhospitals. Following the program there was improved adherenceto a checklist including selection of appropriate endotrachealtube size, laryngoscope blade size, and use of a cuffed tube. The authors suggest this model might be used to improvemanagement of a number of pediatric critical conditions.
Izukura and others evaluated the impact of phototherapy on dyspnea in healthy adults. Using a near-infrared device often used to treat pain, the authors evaluated dyspnea while subjectswere connected to inspiratory resistances of 0-30 cm H2O/L/s. In healthy volunteers, phototherapy reduced dyspnea as measuredby the Borg scale. The role in patients with respiratory disease is unknown.
Heart rate variability (HRV) is a sign of normal autonomic physiologic function. Pimentel et al evaluated HRV in subjects with amyotrophic lateral sclerosis (ALS) across a range oflung function. They found that HRV was reduced in ALS subjects with lower lung capacity. Loss of normal physiologicvariability is a common finding in disease.
Morgan and others evaluated the effect of changing apnea time during noninvasive neurally-adjusted ventilatory assist(NAVA). Both short and long apnea times have advantagesand disadvantages. In a short cross-over trial, short apneatimes were associated with more frequent periods of back-upventilation and fewer instances of hypoxia and tachycardia.
Papolos and colleagues evaluated the use of deadspacemonitoring in ARDS and the relationship to right ventricular dysfunction. Subjects with ARDS had serial deadspace and pulmonary hemodynamic measurements during ventilatorysupport. They found that increases in deadspace wereassociated with changes in pulmonary hemodynamics whichmight lead to right ventricular dysfunction. They suggest that serial deadspace measurements might identify patients at riskfor cor pulmonale.
Tyler et al conducted a quality improvement project aimed at reducing the need for home oxygen therapy in very lowbirth weight infants at discharge. Using a room air challenge,an oxygen reference chart and standardized oxygen deliveryguideline were developed and implemented. They reported that standardization of convalescent respiratory care practices reduced respiratory morbidities in these infants.
Lian et al studied factors associated with full-time employment in adult subjects with cystic fibrosis. They foundthat higher levels of education were associated with full timework and that absenteeism was an issue in approximately halfof subjects.
Ampatzidou and coworkers retrospectively reviewed theuse of NIV following cardiac surgery. The presence of COPD, comorbidities, and renal dysfunction were associated withNIV use. NIV failure occurred in just 11% of subjects. They concluded that NIV was successful in treating post-cardiac surgery respiratory failure in a majority of cases.
Charbonney and colleagues provide a narrative reviewon the optimization of ventilation during cardiopulmonaryresuscitation. Their unique observations on the impact of chest compressions on lung volume and airway closure suggestchanges to the standard ventilation techniques currently taught.
Davies contributes a Year in Review covering important papers on the use of NIV in adults. This includes new research and guidelines.
Ridwan and others contribute a systematic review on the roleof translational care on COPD readmissions. They identifiedfactors associated with reduced all-cause hospital readmissionsincluding the duration of the intervention and the type of careproviders.
Ørtenblad et al provide a systematic review of subjectperceptions while receiving home mechanical ventilation. This review details subjects' concerns regarding autonomy and technology dependence.
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